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Vol. 34. Núm. 5.Mayo 1998
Páginas 229-276
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Vol. 34. Núm. 5.Mayo 1998
Páginas 229-276
DOI: 10.1016/S0300-2896(15)30431-2
Acceso a texto completo
Utilidad de la punción transbronquial y la mediastinoscopia en la estadificación ganglionar mediastínica del carcinoma broncogénico no microcítico. Estudio preliminar
The usefulness of transbronchial needle aspiration and mediastinoscopy for staging mediastinal nodes in non small cell bronchogenic carcinoma. A preliminar study
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C. Disdier*, J. Sánchez de Cos, J.F. Masa
Unidad de Neumología. Hospital San Pedro de Alcántara. Cáceres
G. Varelaa, O. Bengoecheab, M. Jiméneza, J. Garínc, J.J. Cruzd
a Secciones de Cirugía Torácica, Hospital Universitario de Salamanca
b Servicios de Anatomía Patológica, Hospital San Pedro de Alcántara. Cáceres
c Servicios de Radiodiagnóstico. Hospital San Pedro de Alcántara. Cáceres
d Secciones de Oncología Médica. Hospital Universitario de Salamanca
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Información del artículo

Estudio preliminar que tiene por objetivo conocer la sensibilidad (S) y especificidad (E) de la punción transbronquial (PTB) en comparación con la mediastinoscopia/me- diastinotomía anterior (MED/MEDA), y/o toracotomía en la estadificación ganglionar mediastínica del carcinoma no microcítico (CNM). Se analizó la S y E de la TAC como técnica utilizada para la selección de pacientes.

Fueron evaluados 33 pacientes con CNM sin metástasis a distancia y con buena función pulmonar. Se realizó una TAC torácica previa a la broncoscopia en 27 enfermos y antes de la cirugía en el resto. La estadifícación por PTB se realizó en las regiones ganglionares consideradas patológicas en la TAC y en la región subcarinal cuando no se pudo disponer de la información de la TAC antes de realizar la broncoscopia. Los resultados de la PTB se compararon con la MED/MEDA y/o toracotomía.

La prevalencia de enfermedad ganglionar metastásica fue del 47%. En 24 pacientes la TAC detectó ganglios mediastínicos agrandados y en 9 casos el estudio ganglionar mediastínico por imagen fue considerado normal. La S y E de la TAC fue del 93 y 54%, con un valor predictivo positivo (VPP) del 68% y un valor predictivo negativo (VPN) del 87,5%. Para la MED/MEDA la S fue del 73% y la E del 100%, siendo los VPP y VPN del 100 y 75%, respectivamente. La S y E de la PTB fueron, respectivamente, del 36 y del 92%, con un VPP del 83% y un VPN del 57%. Un paciente sufrió un neumotorax con empiema pleural tras la MED que pudo ser evitado al ser previamente positiva la PTB.

La PTB es una técnica útil y segura en la estadificación ganglionar del CNM. Aunque la sensibilidad de la PTB es menor que la de la MED, la PTB permite analizar regiones de difícil acceso para la MED y puede hacer innecesaria la realización de esta última si se ha obtenido una punción positiva para malignidad. La TAC torácica es una técnica sensible pero poco específica para determinar la presencia de afectación ganglionar metastásica.

Palabras clave:
Cáncer de pulmón
Punción transbronquial
Es- tadificación
Mediastinoscopia
Tomografía axial computarizada

Preliminary study to compare the sensitivity and specificity of transbronchial needle aspiration (TBNA) and mediastinoscopy/anterior mediastinotomy (MED/AMED) and/or thoracotomy for staging of mediastinal nodes in non-small cell carcinoma. To determine the sensitivity and specificity of computerized tomography (CT) as a screening technique.

Thirty-three patients with non-small cell carcinoma but no remote metastasis and good lung function were evaluated. A chest CT scan was performed before bronchoscopy in 27 patients and before surgery in the others. Nodular areas considered diseased based on CT images were staged by TBNA. When CT images were not available before bronchoscopy, TBNA for staging was performed in the subcarinal region. Results by TBNA were compared with those obtained by MED/AMED and/or thoracotomy.

The prevalence of metastatic nodular disease was 47%. CT detected enlarged mediastinal nodes in 24 patients; the images were considered normal in 9 patients. Sensitivity and specificity of CT was 93% and 54%, respectively, with a positive predictive value (PPV) of 68% and negative predictive value (NPV) of 87.5%. The sensitivity and specificity of MED/AMED were 73% and 100%, respectively; PPV was 100% and NPV was 75%. The sensitivity and specificity of TBNA were 36% and 92%, respectively; PPV was 83% and NPV was 57%. The pneumothorax with pleural empyema suffered by one patient after MED could have been avoided, given that the earlier TBNA was positive.

TBNA is a safe, useful technique for staging nodes in non-small cell carcinoma. Although the sensitivity of TBNA is lower than that of MED, regions that are difficult to reach with the latter technique can be sampled by TBNA. Furthermore, MED can be rendered unnecessary by positive TBNA results. CT imaging of the chest is sensitive but its specificity is low for detecting ganglial metastasis.

Key words:
Lung cancer
Transbronchial needle aspiration
Staging
Mediastinoscopy
Computed axial tomography
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